IMMUNE THROMBOCYTOPENIA AND PREGNANCY: A SPANISH CASE SERIES OF 270 PREGNANCIES IN PRIMARY ITP.
(Abstract release date: 05/18/17)
EHA Library. González-López T. 05/18/17; 182820; PB2106
Dr. Tomás José González-López
Contributions
Contributions
Abstract
Abstract: PB2106
Type: Publication Only
Background
Effect of pregnancy on the course of primary immune thrombocytopenia (ITP) is not well known. Besides, due to the lack of clinical assays, evidence about outcome predictors of pregnants and neonates born to mothers with ITP is scarce.
Aims
To evaluate management and results of pregnancy and delivery on pregnant ITP women and on their offspring.
Methods
All women diagnosed of primary ITP (according to international consensus criteria) from 2011 to 2016 in 23 Spanish Hematology Departments who had at least one pregnancy after ITP onset were included in this registry.
Results
We included 270 primary ITP pregnancies from 184 women. At pregnancy diagnosis, we observed a majority of chronic ITP cases (71.4 %). At ITP diagnosis, median age of our case-series was 23 years (IQR, 19-29) and median platelet count was 18 x 109/l (IQR, 6-35). Median time from ITP diagnosis to pregnancy was 167 months (IQR, 0-366). Median number of pregnancies prior to ITP diagnosis were 1 (IQR, 0-2) with 1 pregnancy (IQR, 1-2) after ITP diagnosis as a median.
50.8% of women received corticosteroids, immunoglobulins (IVIG) (16.9%), rituximab (6.8%) and/or splenectomy (8.4%) as ITP treatments between or before new pregnancies. On the other hand, 26.4% of women needed treatment for ITP during pregnancy, mainly steroids (13.5%) and IVIG (10.2%).
The median platelet-count nadir during pregnancy was 74 x 109/l (IQR, 36-172). 127 (47%) pregnancies suffered from non-haemostatic platelet levels (less than 50 x 109/l) with 73 (27.0%) women who achieved less than 30 x 109/l. 56 (20.7%) women exhibited hemorrhagic symptoms, being 30 (11.1%) of them severe bleedings.
Regarding type of delivery, this was vaginal in 63.4% of pregnancies and cesarean sections 30.5%. Median platelet count at delivery was 110 x 109/l (IQR, 76-181). 43 patients (23.4%) experienced 57 bleeding episodes.
We only observed 48 cases (20.4%) of neonatal thrombocytopenia among 235 living newborns.
Conclusion
Our results are comparable to previously reported studies. No severe bleeding complications during pregnancy and/or delivery were observed in our case series. Rate of neonatal thrombocytopenia, and therefore, newborn bleeding is low.
Session topic: 32. Platelets disorders
Keyword(s): Pregnancy, Idiopathic thombocytopenic purpura (ITP)
Abstract: PB2106
Type: Publication Only
Background
Effect of pregnancy on the course of primary immune thrombocytopenia (ITP) is not well known. Besides, due to the lack of clinical assays, evidence about outcome predictors of pregnants and neonates born to mothers with ITP is scarce.
Aims
To evaluate management and results of pregnancy and delivery on pregnant ITP women and on their offspring.
Methods
All women diagnosed of primary ITP (according to international consensus criteria) from 2011 to 2016 in 23 Spanish Hematology Departments who had at least one pregnancy after ITP onset were included in this registry.
Results
We included 270 primary ITP pregnancies from 184 women. At pregnancy diagnosis, we observed a majority of chronic ITP cases (71.4 %). At ITP diagnosis, median age of our case-series was 23 years (IQR, 19-29) and median platelet count was 18 x 109/l (IQR, 6-35). Median time from ITP diagnosis to pregnancy was 167 months (IQR, 0-366). Median number of pregnancies prior to ITP diagnosis were 1 (IQR, 0-2) with 1 pregnancy (IQR, 1-2) after ITP diagnosis as a median.
50.8% of women received corticosteroids, immunoglobulins (IVIG) (16.9%), rituximab (6.8%) and/or splenectomy (8.4%) as ITP treatments between or before new pregnancies. On the other hand, 26.4% of women needed treatment for ITP during pregnancy, mainly steroids (13.5%) and IVIG (10.2%).
The median platelet-count nadir during pregnancy was 74 x 109/l (IQR, 36-172). 127 (47%) pregnancies suffered from non-haemostatic platelet levels (less than 50 x 109/l) with 73 (27.0%) women who achieved less than 30 x 109/l. 56 (20.7%) women exhibited hemorrhagic symptoms, being 30 (11.1%) of them severe bleedings.
Regarding type of delivery, this was vaginal in 63.4% of pregnancies and cesarean sections 30.5%. Median platelet count at delivery was 110 x 109/l (IQR, 76-181). 43 patients (23.4%) experienced 57 bleeding episodes.
We only observed 48 cases (20.4%) of neonatal thrombocytopenia among 235 living newborns.
Conclusion
Our results are comparable to previously reported studies. No severe bleeding complications during pregnancy and/or delivery were observed in our case series. Rate of neonatal thrombocytopenia, and therefore, newborn bleeding is low.
Session topic: 32. Platelets disorders
Keyword(s): Pregnancy, Idiopathic thombocytopenic purpura (ITP)
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